title: How long do acute coronary syndrome patients wait for reperfusion, diagnostic coronary angiography and surgical revascularisation?
abstract: OBJECTIVE
  To describe the components of in-hospital waiting time to investigation and management in patients with acute coronary syndromes (ACS) admitted to the Middlemore Hospital (MMH) Coronary Care Unit.
  
  
  METHODS
  We examined the time to (1) reperfusion therapy in ST-elevation myocardial infarction (STEMI), (2) coronary angiography in ACS, and (3) surgical revascularisation. Data was collected prospectively for consecutive patients via the Acute PREDICT ACS registry.
  
  
  RESULTS
  Of 280 STEMI admissions in 2009 and 2010, 101 underwent primary percutaneous coronary intervention. The median door-to-balloon time when performed on site at MMH was 83 minutes (IQR 69-101 minutes) compared with 135 minutes (IQR 112-165 minutes) for those transferred after hours to Auckland City Hospital (ACH). Of 2115 ACS admissions between 2007 and 2010 84% underwent inpatient coronary angiography and 69% of these underwent this within 3 days. The strongest predictors of a >3 day delay were advanced chronic kidney disease (odds ratio 3.68, 95% CI 2.08-6.51) and presenting late in the week (odds ratio 2.85, 95% CI 2.30-3.54). 329 patients (16%) underwent coronary artery bypass graft surgery (CABG). The median time from admission to inpatient CABG was 13 days and from discharge to outpatient CABG was 155 days. Of ACS patients referred for outpatient surgery in the public sector 38% were readmitted with further ACS whilst waiting.
  
  
  CONCLUSIONS
  Important delays were identified across the spectrum of post-admission care for ACS patients potentially impacting on both patient outcomes and the cost of care. Active quality improvement programmes to reduce delays are required.
authors.affiliation: Middlemore Hospital, Auckland, New Zealand.
authors.forename: Jamie
authors.initials: J
authors.lastname: Voss
authors.forename: Andrew
authors.initials: A
authors.lastname: Martin
authors.forename: Imogen
authors.initials: I
authors.lastname: Caldwell
authors.forename: Mildred
authors.initials: M
authors.lastname: Lee
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kerr
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061185:Mechanical Thrombolysis / Q000706:statistics & numerical data*; D008485:Medical Audit; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy; D009520:New Zealand; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data; D010360:Patient Transfer; D017410:Practice Guidelines as Topic; D013997:Time Factors